This study directly responds to NIOSH PAR 12-252 which specifically requests proposals that enhance our understanding of risks and conditions associated with occupational diseases and injuries and add to scientific knowledge by examining a population whose health and safety is seldom investigated. Results from this study will provide information necessary for designing new institutional surveillance systems and interventions to prevent adverse occupational health outcomes among pediatric healthcare providers (PHCPs). Healthcare personnel routinely encounter health and safety hazards with consequences that affect the employee (through turnover, job satisfaction, performance and overall health), the patient (through poorer quality of care and safety), and the organization (through lost work-time, compensation claims, job replacement/training and poor perception of organizational commitment to health/safety). Accurate data on risk factors, the incidence of near- misses and injuries, and their time trends are essential for developing interventions to reduce the burden of work-related adverse health outcomes. However, research has shown that injury under-reporting in healthcare is common due to time constraints, reluctance to report, symptom self-management, peer pressure not to report, frustration with workers' compensation procedures, a sense of 'normalcy' of being injured and fear of reprisal. To facilitate accurate and timely injury reporting, surveillance systems need to be supported by clear practice policies encouraging injury reporting and near-misses, that if ignored may lead to harm for both staff and patients. The importance of near-misses has long been integrated in the surveillance systems of other high-risk industries such as aviation, nuclear facilities and the military because each occurrence contributes to an understanding of potential failure patterns that may be antecedents of more severe injuries. The study's objectives are to: determine the frequency and type of near-misses and injuries among PHCPs and assess the feasibility of using a real-time data collection method as the basis for active injury surveillance in healthcare organizations. A secondary objective is to assess the relationship of individual and work factors with these events. The objectives will be achieved by the following specific aims: 1) Determine the number of near-misses and injuries experienced by PHCPs working in a freestanding pediatric hospital; 2) Compare voice recording and conventional data collection; 3) Evaluate the feasibility of an active surveillance system based on voice recording; and 4) Evaluate the association of individual and work factors on near-misses and injuries. Randomly selected PHCPs will record near-misses and injuries on voice recorders for a total of 1,000 two-week periods. Injuries reported through institutional surveillance will be compared to voice-recorded reports to determine the prevalence of under-reported injuries. Surveys and focus groups will be used to assess reporting preference and feasibility. Surveys at baseline and study completion will measure individual and work factors and their associations with injuries and near-misses.